April 29, 2015
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Hospital quality affects long-term survival for patients with acute MI

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Patients with acute MI who were admitted to high-performing hospitals had better long-term survival than those admitted to low-performing hospitals, according to data published in Circulation: Cardiovascular Quality and Outcomes.

The survival benefit was observed in the first 30 days and persisted long term, researchers found.

According to the study background, previous research has shown that patients with acute MI admitted to high-performing hospitals had better short-term mortality rates than those admitted to low-performing hospitals. Emily M. Bucholz, MD, MPH, and colleagues investigated whether the same is true for long-term survival.

Emily M. Bucholz, MD, MPH

Emily M. Bucholz

Bucholz, from the Yale University Schools of Medicine and Public Health, and colleagues analyzed data from the Cooperative Cardiovascular Project, a study of Medicare beneficiaries hospitalized for acute MI with up to 17 years of follow-up (n = 119,735 admitted to 1,824 hospitals).

The researchers compared life expectancy in patients admitted to hospitals with low and high 30-day risk-standardized mortality rates. They calculated life expectancy for patients in each decile and years of life lost per 1,000 patients to quantify differences in life expectancy across hospital deciles.

The survival curves for patients in each decile separated within the first 30 days and remained separated throughout 17 years of follow-up, with life expectancy estimates declining with greater risk standardized mortality rate.

Those admitted to hospitals in the decile with the lowest 30-day risk-standardized mortality rate lived a mean of 6.44 (standard error, 0.06) years after acute MI vs. 5.54 (standard error, 0.06) for those admitted to hospitals in the decile with the highest 30-day risk-standardized mortality rate, according to the researchers.

For every 1,000 patients treated at low-performing hospitals, 898 (standard error, 162) years of life were lost compared with patients treated at high-performing hospitals, they found, noting that the results did not change after adjustment for patients characteristics and treatment.

Patients in the lowest-performing hospitals lost 1,124 (standard error, 123) years per 1,000 patients treated compared with patients in the highest-performing hospitals, they reported.

When 30-day survivors were examined separately, there was no difference in adjusted or unadjusted life expectancy across hospital deciles, according to the researchers.

This abstract was originally prepared for presentation at the American Heart Association’s Quality of Care and Outcomes Research Scientific Sessions, which was cancelled due to protests and an ongoing state of emergency in Baltimore. – by Erik Swain

Disclosure: Bucholz reports no relevant financial disclosures.